Intensification of Blood Pressure Lowering Therapeutics Based on Diuretics Versus Usual Management for Uncontrolled Hypertension IN Patients With Moderate to Severe Chronic Kidney Disease

Exclusion Criteria

• •Patient following any measures of legal presentation
• •Pregnant or breastfeeding woman
• •woman of childbearing without a highly effective contraceptive measure (combined or progestogen-only hormonal contraception associated with inhibition of ovulation, intrauterine device or intrauterine hormone-releasing system)
• •Clinical signs of hypovolemia
• •Symptomatic orthostatic hypotension
• •Hyponatremia (\<130 mmol/L)
• •Dyskalemia (\<3,5 mmol/L or \>5,5 mmol/L)
• •Major adverse cardiovascular event during the last three months: myocardial infarction, heart failure hospitalization, stroke
• •Current medical history of cancer requiring chemotherapy
• •Solid organ transplantation
• •Two or more diuretic agents (loop diuretic, thiazides and thiazide-like diuretics)
• •Mineralocorticoid receptor antagonists
• •Autosomal dominant polycystic kidney disease treated with Tolvaptan
• •Contraindication to diuretics involved in the algorithm
• •Severe heart failure (NYHA III\_IV)
• •Cirrhosis Child B-C